Methamphetamine users could reverse CV damage by quitting
CV damage due to methamphetamine use can be reversed by quitting combined with medical treatment, according to results published in JACC: Heart Failure.
According to the researchers, encouraging methamphetamine users to quit has the potential to prevent drug-related cases of HF and other CV outcomes in the future.
“Methamphetamine-associated cardiac myopathy will become a growing cause of [HF] in young adults,” Norman Mangner, MD, physician at the Heart Center Leipzig in Germany, said in a press release. “Due to the chance to recover cardiac function and symptoms at an early stage of disease, early detection of heart problems in patients with methamphetamine abuse could prevent further deterioration of the cardiomyopathy. ... Rather than simply placing patients with suspected methamphetamine-associated cardiomyopathy on a cocktail of neurohormonal blockade, the majority of focus should be on helping such patients quit.”
Mangner and colleagues recruited 30 patients (mean age, 30 years; 93% men) with a history of methamphetamine abuse who also had left ventricular ejection fraction < 40% and endomyocardial biopsy at initial diagnosis.
Although baseline characteristics were collected retrospectively, follow-up characteristics were collected prospectively with visits in Leipzig for clinical and echocardiographic evaluation.
The primary endpoint was a composite of death, nonfatal stroke and rehospitalization for HF. Mean follow-up was 37 months for patients who discontinued methamphetamine abuse and 27 months for patients who did not.
A total of 83.3% of the predominantly male patient population had NYHA functional class III or IV dyspnea.
An echocardiograph conducted by researchers revealed marked LV dilatation (mean LV end-diastolic diameter, 67.1 ± 7.4 mm) and impaired LV ejection fraction (mean, 19 ± 6%). Intraventricular thrombi were present in one-third of patients.
Endomyocardial biopsy determined markers of inflammation and fibrosis, and fibrosis correlated with the duration of methamphetamine abuse, the researchers wrote.
At follow-up, the combination of discontinued methamphetamine abuse combined with medical therapy partially improved cardiac function (LV ejection fraction, 19 ± 6 vs. 43 ± 13; P < .001) and symptoms (P = .056). Patients with continued abuse, however, did not show any improvement, Mangner and colleagues wrote.
There was an independent association between improvement in cardiac function and the extent of fibrosis.
The primary endpoint was more common in patients with continued methamphetamine abuse (57.1% vs. 13%; P = .037), according to the researchers.
Step toward understanding
The study “serves to establish an important basic foundation of what will be ultimately required: a comprehensive examination of the cardiac effects of all major illicit substances that uses cutting-edge imaging technology and biomarker assessments,” Tariq Ahmad, MD, MPH, of the section of cardiovascular medicine at Yale University School of Medicine, and colleagues wrote in a related editorial.
“The destructive nature of substance abuse ranges from its harmful effects on individual health to tearing apart the social fabric,” Ahmad and colleagues wrote. “[The researchers] should be congratulated for taking a step toward improving our understanding of the CV toxicities of one of the most common drugs of abuse.” – by Dave Quaile
Disclosure: The researchers and editorial authors report no relevant financial disclosures.